Impact of Human Milk-Based Fortifiers in Premature Babies

Introduction

Premature birth means being born too early, before 37 weeks of pregnancy. This can cause challenges in the growth and development of babies. Babies born too early have more problems, like trouble eating, not gaining enough weight, and not getting enough nutrients. It is widely known that breast milk is the best food for babies, but premature babies have special needs for their nutrition that might not be fulfilled only by breast milk. The growth of premature infants can be supported by incorporating human milk fortifiers into their diet. These fortifiers make breast milk even better for premature babies.

What Are Human Milk-Based Fortifiers?

Human Milk-Based Fortifiers (HMBFs) are special supplements that make human milk more nutritious for babies who need extra nutrients. They are often given to premature or medically fragile babies. Human milk fortifiers are made to be like human breast milk but with additional calories, protein, vitamins, and minerals. This helps babies who need extra support to grow and develop. HMFs are commonly used in Neonatal Intensive Care Units (NICUs) when a mother's breast milk alone may not provide enough nutrients for a premature or sick baby.

What Are the Benefits of Fortified Breastmilk in Premature Babies?

Enhanced Nutritional Content - Human milk-based fortifiers are derived from human milk, making them bioavailable and well tolerated by premature infants. These fortifiers are designed to boost the concentration of essential nutrients like proteins, calories, vitamins, and minerals, bridging the gap between breast milk and premature infants' requirements.

Improved Growth and Development - Premature infants are at risk of inadequate weight gain and delayed growth. HMBFs help address these concerns by offering higher caloric density and protein content. This supplementation supports catch-up growth, minimizing the risk of long-term growth deficits and developmental delays.

Reduced Morbidity and Mortality - Human milk-based fortifiers have been associated with a decreased incidence of morbidities common among premature infants, such as Necrotizing Enterocolitis (NEC), sepsis, and bronchopulmonary dysplasia. The added nutrients and bioactive components in these fortifiers improve gut health, enhance immune function, and reduce the risk of infection, leading to better overall outcomes and reduced mortality rates.

Neurodevelopmental Advantages - HMBFs have important fats called essential fatty acids, one of which is called Docosahexaenoic Acid (DHA). This DHA fat is necessary for properly developing the brain and thinking and learning. Research has found that babies born too early fed with fortified breastmilk with added nutrients have better brain development and skills, like thinking, seeing, and moving, compared to babies who do not get this fortified milk.

How Do Human Milk-Based Fortifiers Affect Necrotizing Enterocolitis in Premature Babies?

Necrotizing Enterocolitis (NEC) is a very serious illness that mainly affects babies who are born too early, especially those who are being cared for in special units for newborn babies. This problem causes irritation and damage to the intestines, which can become very serious and lead to the death of the tissue in extreme situations.

The exact cause of why NEC occurs is unknown. Still, it is believed that factors like the baby's intestines not developing properly, changes in the gut bacteria, and insufficient blood going to their intestines might play a role in causing it.

Breast milk-based fortifiers can decrease the chances of necrotizing enterocolitis in premature babies. Human milk has many bioactive components that can help babies grow strong and healthy. It has substances like immunoglobulins, protective enzymes, and growth factors that protect the baby’s intestine and help it grow properly.

Research has found that giving premature babies breast milk, either on its own or with additional nutrients, lowers their chances of getting NEC compared to formula milk. Human milk-based fortifiers are better than cow's milk-based fortifiers for preterm infants. T

What Are the Challenges Associated With Human Milk-Based Fortifiers for Premature Babies?

• Availability and Cost - Some healthcare settings may not have human milk-based fortifiers easily accessible and may be expensive, making it difficult for people to access them.

• Feeding Tolerance and Digestive Concerns - Some premature infants may experience feeding intolerance or digestive issues when introducing fortified human milk. Careful monitoring of the baby's tolerance, adjustment of fortification levels, and support for proper digestion are necessary to minimize these challenges.

• Standardization and Consistency - Currently, there are no standardized protocols and guidelines regarding the composition and administration of human milk-based fortifiers. Consistency in fortifier formulation and preparation is essential to provide uniform and reliable nutritional supplementation.

• Long-term Outcomes - While short-term benefits have been well-documented, further research is needed to evaluate the long-term safety and outcomes associated with human milk-based fortifier supplementation. Studies monitoring growth, neurodevelopment, and potential adverse effects are essential for establishing evidence-based practices.

What Do Studies Say About Human Milk-Based Fortifiers for Premature Babies?

Many studies have been carried out about the impact of human milk-based fortifiers on premature infants. Some of them are listed below:

• In 2017, Sullivan S. et al.conducted a randomized controlled trial comparing human milk-based fortifiers to cow's milk-based fortifiers in very low birth weight infants. The study found that infants receiving HMF had reduced Necrotizing Enterocolitis (NEC) rates and improved weight gain compared to those receiving cow's milk-based fortifier.

• Another study evaluated the impact of an exclusive human milk diet fortified with human milk-based fortifiers in extremely premature infants. This study demonstrated lower rates of NEC, improved feeding tolerance, and better growth outcomes in infants receiving the exclusive human milk diet with human milk-based fortifiers.

• Assad M. et al. conducted a retrospective cohort study comparing infants who received exclusive human milk feedings with human milk-based fortifiers versus those receiving formula supplementation. The study found that infants in the human milk-based fortifier group had a lower incidence of NEC and better growth outcomes.

• Cristofalo EA. et al. investigated the association between human milk-based fortifier use and neurodevelopmental outcomes in very low birth weight infants. The study showed that infants receiving human milk-based fortifiers improved cognitive and motor development.

• In 2016, a systematic review and meta-analysis of studies evaluating the impact of human milk-based fortifiers on clinical outcomes in premature infants was conducted. This analysis showed that using human milk-based fortifiers was associated with a reduced risk of NEC, improved growth, and enhanced neurodevelopmental outcomes.

Conclusion

Human milk fortifiers are crucial for helping premature babies get the nutrients they need for proper growth and brain development. Fortifiers help make breast milk more nutritious, which helps babies grow and develop better, lowers the chances of having nutrient deficiencies, and provides lasting benefits for their overall development.